Medical doctors as chiropractic patients

I saw a new patient this week in our chiropractic office in Rochester who is a medical professional. This is nothing novel as we have a lot of medical workers as patients. What was interesting however was this patient said she had asked her colleagues and none of them saw a chiropractor. Really? None of them? Surprising.

There was a time when the medical profession eschewed chiropractors but as the literature changed and (the better) chiropractors focused on science over superstition, those tables have turned. Still, when the occasional medical doctor or registered nurse questions the clinical veracity of what we do, I like to remind them of several important points:

First, these is no evidence of excess risk of vertebrobasilar artery (VBA) stroke from chiropractic care compared to medical treatment. None. This is not an opinion. We can point to the studies, back it up with research and factual evidence.

Second, recent studies show that patients with low back pain and neck pain do not add to overall medical spending seeing a chiropractor versus other types of medical care. This is based on a survey of 12,000 respondents. In fact, seeing a chiropractor results in a 20-40% decrease of costs in lower back pain compared to MD treatment.

Third, there are many clinical reviews of spinal manipulation for low back pain and it has been shown to be more effective in the short term for many cases and probably the most effective treatment for chronic low back pain patients.

Fourth, patients like seeing a chiropractor over most other health care treatments and isn’t having a compliant patient who is happy half the journey toward recovery?

I also remind my physician and medical worker patients that in our practice, we limit our focus to neuromusculoskeletal issues and treat with a biomechanical focus. That means no magic, no chanting, no candles. Just well evidenced, science based treatments that are worthy of their referrals.

The real question is why don’t more medical doctors, PAs and nurses refer appropriate patients to responsible chiropractors and see them for their own back and neck pain?

Dr. Brett Kinsler is a practicing chiropractor in Rochester, NY. Our practice is evidence based and spine focused.

 

 

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Randy Ferrance, DC MD, bridging the gap between chiropractic and medicine

Podcast with chiropractor medical doctor who bridges the gap between the two professions

Dr. Randy Ferrance is a medical physician who was a practicing chiropractor when he entered medical school. Raised in an evangelical chiropractic family, he wasn’t vaccinated as a child. He speaks on bridging the gap from chiropractic to medicine, on his experiences making the transition from chiropractic to medicine and on how chiropractors can best develop working relationships with medical doctors.

Does Dr. Ferrance experience prejudice for being a chiropractor/medical doctor? Yes…but it’s not from whom you’d think.

Interview conducted with Dr. Brett L. Kinsler.

Get the podcast here or look for OnTheOtherHand Podcast on iTunes.

This podcast episode was sponsored by XSite Pro website design and management software. The software I use for my own office website.  Try their software with a 30 day money back guarantee.

YouTube Video Promo for the On The Other Hand Podcast

I keep being told that in order to maximize our exposure with the podcast, we need to also have some video. I produced this video promo in order to let more people know about the project in which we help to uncover more scientific, ethical, intelligent people in chiropractic, alternative medicine and health care.

Edzard Ernst, CAM Critic, Talks with Dr. Brett Kinsler on Chiropractic and Bias

Book by Edzard Ernst complementary and alternative medicine

Professor Edzard Ernst, MD, PhD, FRCP, FRCP holds the Laing Chair in Complementary Medicine at the Peninsula Medical School, University of Exeter and is the Editor-in-Chief of two medical journals. He has also been seen as a major public opponent of chiropractic and alternative medicine. He has devoted most of his career to publishing articles that are critical of complementary and alternative medicine….an unbelievable number of papers. Like 1500 or so. He’s been especially critical of chiropractic and, in the opinion of many researchers, has glossed over important research and exaggerated results. To me, what’s most interesting about Ernst is that he claims objectivity and lack of agenda. This podcast asks some tough questions of Prof. Ernst.

You can get the podcast episode on iTunes by searching the podcast section for “On The Other Hand” or you can just click here.

Thanks to this episode’s sponsor: Audible.com, the audiobook company. Get a free audiobook download just by trying their service free for 14 days.

Freezing Cold Electrodes? Not Anymore!

I live and practice chiropractic in Rochester, NY right smack in the middle of the upstate New York snow belt. And I know it’s hard for you to believe but it does get a tad bit chilly around here…even in the winter time. Seriously.  Now, on occasion in our office, we use some electric modalities with patients (electric muscle stimulation, interferential, etc.) and one thing always bothered me. Generally, when we choose to use one of these modalities, it is because of overly tight muscles or splinting (settle down there Ben Franklin, we can talk about the research in another post). And regardless of whether we used the sticky electrodes or the 3 x 5″ carbon electrodes that were sprayed with water (my economical preference), patients always jumped just a bit from the cold electrodes. This seemed counter-productive — especially when we are talking about people who are in pain and spasm and shouldn’t be exposed to a shock that makes them jump at all.

Several times per day, I would hear myself say, “Sorry, these are going to be a bit cold.”
To which the patient would respond, “Arrrrrgh! Holy crap, is that cold!”

Not the greatest strategy for patient comfort, retention and bedside manner.

So five years ago, I decided to take it as a personal challenge to solve the problem of the freezing cold carbon electrodes. First, I tried heating the water in the spray bottles we used. I got a desktop coffee cup heater and rested the spray bottle on that. I also tried ultrasound gel warmers and a few other strategies. No help. The water stayed warm but once the water hit the air, it was almost as cold as without heating it. And keep in mind, 72 degree room temperature water is awfully chilly to a 98.6 degree body.

After several experiments I determined that the only way to consistently deliver comfortably toasty electrodes to the patient would be to actually heat the electrodes. Then, once the water hit them, they would still feel warm. But how? We have a microwave in the office but this seemed like a terrible idea for the degradation of the carbon. I was also afraid it would become uncomfortably hot and perhaps even cause burns. Another idea was to dunk them in a hydrocollator but I didn’t have one in every treatment room and had no intention of buying a bunch of hot water tanks at $250 a pop. Not to mention the space they take up and the horrible prospect of a kid turning his arm into soup. It also made the electrodes really wet and patients didn’t dig that too much.

The perfect solution would be something that I could rest the electrodes on and keep them at a safe, steady temperature.  It would need to be small, be able to stay on all day without over heating and be safe around little patients’ little fingers.

In the unlikeliest of places, I actually found it! A small, thin, flat heating element that stayed at 100 degrees Fahrenheit. No more, no less. The device is meant to be kept on all day long with no danger of overheating. You can turn them off at night and they warm up quickly in the mornings. They are safe to touch. They don’t wear out the electrodes and they cost under 15 bucks!

I bought four of them and they have been in constant service for 5 years.  None have failed. None have caused patient burns. And best of all, there have been no chilly electrodes.  I can use them with the carbon or the sticky ‘trodes.  I sandwich the paper-thin heater between two pairs of electrodes and usually toss a package of stickies on top.  Now patients say, “Ohh, that’s nice and toasty. Like a spa.”

I can live with that.  Bring it on, Winter! I’m ready for ya, Tough Guy!

I searched around since the store I initially got these heaters no longer carries them but I just located them online for a great price! The exact model and brand I have been using can be found here in case you are interested in getting some for yourself.  Yes, it takes you to a pet store website.  No, that is not a mistake.

Too bad you have to get them online, though. I really enjoyed the horrific look I got from the checkout girl when I first purchased mine when her eyes widened and she asked, “Exactly how many cobra snakes do you own?!?”

You will miss that conversation and the wide-eyed checkout girl but you won’t miss your patients cringing from your formerly cold electrodes.

Let me know how it works out for you.

Link to get the “Electrode Heaters” I use.

Is Warren Hammer a Fasciaist?

Fascia is the newest focus in manual medicine. Those fibrous sheets that surround muscle are proving to be the link to all sorts of musculoskeletal problems. In this podcast episode, I interviewed one of the foremost experts on soft tissue manipulation who is bringing some groundbreaking techniques on fascial manipulation to the United States for the first time.

Excited about his recent work with well-known Italian physical therapist Luigi Stecco, Dr. Warren Hammer brings his 50 year experience in chiropractic and soft tissue procedures to his candid talk with me on our On The Other Hand podcast.

The episode can be found on iTunes or here.

Think you know all about chiropractors? Think again.

 

Interview published on the On The Other Hand podcast series by Rochester, NY chiropractor Dr. Brett L. Kinsler.

Tom Hyde, DC is Sports Chiropractic.

Photo of Tom Hyde, DC

Dr. Tom Hyde co-developed Functional and Kinetic Treatment with Rehabilitation, Provocation and Motion (FAKTR-PM).

Tom Hyde, DC has had so many accomplishments and he discusses several of them in an episode of our podcast including how he helped to incorporate chiropractors into the world of professional sports.  Hyde talks about how the barriers were broken to get chiropractic services to Olympic athletes, how he became the chiropractic physician for the Miami Dolphins and he discusses the procedure he co-developed, called FAKTR-PM.

FAKTR-PM stands for “Functional And Kinetic Treatment with Rehabilitation, Provocation and Motion.” It was developed to help speed recovery from chronic musculoskeletal pain syndromes and has also been shown to work extremely well on acute musculoskeletal/fascial conditions.

In 1987, Tom Hyde became the first chiropractor to be accepted to the volunteer program for chiropractors at the United States Olympic Training Center, in Colorado Springs, Colorado, and was subsequently selected to serve as the official chiropractor for the 1987 Pan American Games. In 2001, Hyde was inducted to the Hall of Fame of the Sports Council of the American Chiropractic Association.  In 2002, he was named “Sports Chiropractor of the Year” by the Florida Chiropractic Association Sports Injury Council.  He was named “Person of the Year” by Dynamic Chiropractic in 2009.

He is an avid mountain climber and will soon be going to Kilimanjaro for the 3rd time.  He invited podcast listeners to join him on the climb.

His website www.faktr-pm.com will be changed in January 2011 to www.faktr.com

Find the podcast and show notes at OnTheOtherHand.podbean.com or look for us on iTunes.

 

Functional and Kinetic Treatment with Rehabilitation, Provocation and Motion (FAKTR-PM).

Photo of Tom Hyde, DC

Dr. Tom Hyde co-developed Functional and Kinetic Treatment with Rehabilitation, Provocation and Motion (FAKTR-PM).

Hopsital Based Chiropractor Ian Paskowski on the Podcast!

Ian Paskowski, DC is the medical director of the medical spine care program at Jordan Hospital.  In this episode of On The Other Hand, he discusses delivering high quality spine care in a community based hospital and the future of this type of multi-disciplinary program.  He stresses that the program’s success hinges on patient centered care and in following the NCQA Back Pain Recognition Program guidelines as well as implementing best practices from the medical literature.  Practicing in an environment where medical specialties work together and chiropractors act in back pain triage has proven itself successful for Dr. Paskowski and his medical back pain program.

Find the podcast on iTunes or wherever fine evidence influenced podcasts are offered.  Direct link.

Podcast interview conducted by me, Dr. Brett L. Kinsler, skeptical Rochester chiropractor, blogger and one generally curious cat.

Chiropractic’s Relationship With Research

 

Chiropractor Shawn Thistle discusses chiropractic's relationship with research on the On The Other Hand Podcast.

Chiropractor Shawn Thistle discusses chiropractic's relationship with research on the On The Other Hand Podcast.

Chiropractors have an interesting relationship with research. Some part of the profession uses it to properly guide the manner in which we make clinical decisions.  Some chiropractors only use research when it agrees with what we are already doing to reinforce our decisions. Some use it as marketing tool — no matter how weak the evidence may be.  And some chiropractors ignore research entirely.

I had to opportunity to speak with Dr. Shawn Thistle from Research Review Service.  His company acts to distill down some of the more important research for field practitioners and translate it into a format that is easier to understand and use.  Something like an electronic journal watch personalized for chiropractors. Since he straddles the line between active practice and research liaison, he sits in a unique vantage point.

Dr. Thistle and I spoke on an episode of the On The Other Hand Podcast which can be found on iTunes or here. He also offered listeners to the podcast a discount code if they are interested in his review service subscription.  Enter “OTOH” (which stands for the title of the podcast) during checkout and you can save 25% on subscription fees.  I have no part of this arrangement  –I’m  just passing it along as a friendly thank you to my blog readers and podcast listeners. Enjoy.

Podcast interview conducted by Dr. Brett L. Kinsler.

Just take your vitamin D so we can stop talking about it already

cool hand luke egg scene

"No man can eat fifty eggs"

I know, I know. We’re all sick of vitamin D.  Headline after headline tells us that we don’t get enough, we need to make sure our levels are adequate, that our kids get enough….yada, yada, yaaaawn.

Americans tend to overdue things.  As a nation, we eat too much, we watch too much television, we take too many meds and in general, rely too heavily on ‘supplements’ to catch up with our dietary shortcomings.  And for the most part, the benefits are too few anyhow.  Deep down, we know what to do and study after study confirms what is essentially common sense: eat good food, exercise and don’t smoke.  And that works really well, providing everything the body needs in the right doses and combinations.  What did you say? You knew there was a catch? Yes, you’re very smart.

Take your seats, class.  We’re going to have a quick review of the benefits of Vitamin D:

  • important for bone strength (helps calcium get into and stay in our bones)
  • reduces the risk of seemingly unrelated disease processes like cardiovascular disease, diabetes and cognitive impairment
  • may reduce risk of childhood asthma

Wow. That sounds like some really important stuff.  I rather like my bones unbroken, my heart beating properly, my pancreas unsweetened, my kids non-asthmatic and my cog to be unimpaired (unless purposely impaired with a nice single malt scotch).

How do we know if we need vitamin D and how can we get it? Sorry to pop your gym going, vegan diet eating non-smoking balloon but if you live north of say, Los Angeles or Atlanta, chances are you need it from April to September and really need it from October to March.  Those living in sunnier climates can get enough from sun exposure (about 15-30 minutes a day depending on the pigmentation level of skin).  The rest of us need to get it from our diet or through supplements.  As a general rule, we need 1000-2000 IUs per day.  Some experts recommend less and to just prevent vitamin D deficiency you can take less.  Some recommend taking larger doses but it can build up in the body so for most people, staying in the 1000-2000 IUs per day range will probably give you all the benefits.

Okay, let’s go with the dietary route then.  Usually that’s a better idea than taking supplements, right? What do you have to eat?   According to my  reliable information sources the list of Vitamin D rich foods looks like this: egg yolks, cod liver oil, salmon and other oily fish.  Uh oh.

Remember when eggs were healthy, and then they weren’t and now they are sometimes in small amounts for some people?  For a moment let’s forget about the 212 mg of cholesterol in a large egg and forget about the 5 g of total fat, and completely ignore the link between animal protein and cancer and let’s just look at vitamin D, okay?  One large egg provides (the yolk is where the vitamin D is so egg whites don’t count)…..18-20 IUs.  How can that possibly be a good source of vitamin D?  You would have to eat more than 50 eggs (everyday!) to even come close to 1000 IUs! Didn’t we learn anything from Cool Hand Luke? Ain’t nobody ever eat 50 eggs!  Yet, there they are — on the “top ten foods for vitamin D” lists.  As Miles Monroe might have told us, that’s a big omelette.

Salmon, then, we can eat some salmon.  A three and a half ounce serving of (farmed) salmon has about 245-320 IUs of vitamin D.   Should you decide to splurge and buy wild salmon the same size serving can give you up to 988 IUs.   Although, I don’t think there is any responsible nutritional source that suggests eating any kind of fish everyday or even every other day.   The FDA states that nearly all seafood and shellfish have traces of mercury and/or methylmercury.  Many have more than a trace and can contain unsafe levels of contaminants and are often high in mercury and other environmental toxins that have no place in a healthy diet. Fish also contain no fiber and are high in animal protein, and often, in saturated fat and cholesterol. Hmmm….sounds like a fishy plan to me.

Other sources of vitamin D: fortified foods.  In other words, foods that have nutrients added back in when they are done processing it.  One cup of fortified milk or orange juice has about 100 IUs.  Again, no one should be drinking 10 cups of either of these a day.

No matter how you do this math, you cannot eat your way out of a vitamin D deficiency.  Unless you live in the right climate year round and spend part of everyday walking in the sun with no sunscreen, make a vitamin D supplement part of your daily habit — at least during the darker parts of the year.

Brett L. Kinsler and Michalene Elliott are Rochester Chiropractors who take vitamin D supplements but will happily be guest speakers in tropical locations so they don’t have to.  Their website is www.rochesterchiro.com

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